Toolkit on Hygiene, Sanitation & Water in Schools
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Home > Basic Principles > Technology Options > Anal Cleansing

Anal Cleansing

Anal cleansing is an essential part of overall personal hygiene. Not cleaning after defecation can lead to irritation of the surrounding skin, cystitis (mainly for girls and women), and embarrassment because of odor. Children need to be taught and motivated to follow hygienic anal cleansing practices because unsanitary anal cleansing is the main source of risk for transmission of infections among school children.

Although hygienic anal cleansing is important, discussion of anal cleansing is often ignored in presentations on hygiene and sanitation. The reason for this is that, in almost all cultures, dealing with or touching feces is surrounded by many taboos. Because of these taboos, it sometimes seems easier to "just forget" about the subject.

Partly because of this reluctance to discuss sanitary practices, in some past projects on hygiene, sanitation, and water in schools the project planners and implementers have not understood school children's existing habits for anal cleansing. As a result, inappropriate technological choices have been made, such as constructing flush toilets in schools where children wipe with materials that block the pipe when thrown in the toilet.

This section provides information on different anal cleansing methods. It enables designers to select the toilet technologies that are appropriate for users' preferred cleansing methods, and gives guidelines for instructing children on hygienic anal cleansing.

Cleansing Methods

Figure 1 illustrates the main methods used for anal cleansing. The most commonly available options are water, natural materials, and paper.

Figure 1. A Schoolchild's Options for Anal Cleansing (Drawing by Jaap Zomerplaag)

The use of water is common in countries with Islamic traditions and in Asia. In schools water is used when it is available within the toilet building or school yard. However, the use of water for anal cleansing prohibits the use of certain types of school toilet technologies, such as dry pit toilets, in which water can create problems because of discharge problems in the pit.

Natural materials, such as leaves, corn cobs, and stones, are commonly used in rural areas. While leaves can be an acceptable solution in low-income areas, the use of materials such as corn cobs and stones should be discouraged because it is difficult to use them in a hygienic manner. Normally children collect the materials before entering the toilet. After using the materials, they throw them in the toilet, which leads to rapid filling of the pits and regular blocking of the pipes.

The use of paper, such as old newspapers and in some cases toilet paper, is common in (poor) urban areas where paper can be collected or bought. In some cases, children use pages of their notebooks or textbooks for cleansing. Often, the children throw those papers in the toilet after use, which leads to rapid filling of the pits and regular blocking of the pipes. In cases where the materials are separately collected in a container, they must be hygienically handled.

Which of the above methods school children use depends on several considerations:

  • Cultural setting: Water is commonly used in countries with Islamic traditions and in Asia, while in Latin America wiping materials are most commonly used. In some countries the methods used by men and by women differ.
  • Socioeconomic circumstances: Rich people and many middle-class people in developing countries use toilet paper.
  • Urban or rural location: In urban settings natural materials such as leaves might be scarce, whereas recycled paper might be easy to obtain. In rural areas the opposite is true.
  • Locally available materials: If natural materials are used, the choice of material will depend on which materials are easy to obtain and inexpensive or free.
  • Age group: Children will use materials that they can obtain in safe, accessible locations.

If properly handled, all of the anal cleansing methods described above can be hygienic. Therefore, the decision to change school children's anal cleansing method should be motivated by increased convenience, availability of sufficient materials, or environmental reasons rather than by hygienic arguments. The use of toilet paper should only be considered if the school is in a financial position to always provide paper for all children or if the children can bring their own paper (which will rarely be the case for schools in developing countries).

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Relation of Preferred Anal Cleansing Method to Design of Sanitary Facilities

Table 1. Correlation of Sanitation Technology to Anal Cleansing Method
Method of anal cleansing Sanitation technology
Dry toilets Flush toilets
Water Double chamber ecological toilet with urine and wash water diversion All types
Natural materials Simple pit toiletDouble pit or double chamber ecological toilet with or without urine diversion All types as long as the materials are not disposed of in the toilet
Paper Simple pit toiletDouble pit or double chamber ecological toilet with or without urine diversion All types as long as only toilet paper is used for anal cleansing; for other paper than toilet paper, the paper should not be disposed of in the toilet

Table derived from information provided by Ms. Mayling Simpson-Hebert

As illustrated in figure 2, solid materials used for anal cleansing must be safely collected and disposed of. When the preferred anal cleansing method involves the use of solid materials, a container with lid should be provided in the toilet area for the safe disposal of these. The lid is essential to prevent flies from coming in contact with human feces and potentially transmitting disease. If adolescent girls and women in the school use disposable pads or materials during menstruation, the containers should also be appropriate for the collection of those.

The container for collection of used cleansing materials must be regularly emptied and cleaned. Once the anal cleansing materials are safely collected in a container with lid, those containers have to be regularly emptied and cleaned. The materials can be (1) buried in a hole (as illustrated in figure 2) that has to be covered by enough soil to avoid that animals can excavate it or they should be (2) burned in a safe place. Figure 3 illustrates how solid anal cleansing materials can be disposed of using a simple incinerator.

After emptying the containers they have to be washed with soap. Because the task is not a very attractive one to do, the O&M plan should clearly spell out this responsibility.

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Instruction for School Children on Hygienic Anal Cleansing

Instruction for school children on anal cleansing must motivate them to follow hygienic practices. Instruction needs to cover four basic topics.

  1. Anal cleansing is important. Not cleaning after defecation can lead to skin irritation and cystitis (mainly for girls and women). Not cleaning can also result in embarrassing odors.
  2. Cleansing materials can be collected in the area around the toilet or brought to school if none are available in the toilet building. Children should be taught which materials are safe and appropriate to collect and use, and where to find them.
  3. Solid anal cleansing materials must be discarded safely. Because pits fill up too quickly if solid materials are thrown in and pipes can become blocked if no or insufficient water is available, a lidded container should be placed inside the toilet and children should be taught to place used anal cleansing materials in it and replace the lid tightly.
  4. Hands must be washed after toilet use. Following anal cleansing and material disposal, hands can carry microbes and other pathogens if not properly washed. Human feces are the primary source of disease transmission among school children, particularly for diarrhea and helminth infections. The degree to which children's fingers are exposed to feces depends on the method and materials being used, but children should always wash their hands.

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Cleansing Methods
Implications for Design
Instruction for School Children

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